Loading…
EUS‐guided coil and glue injection versus endoscopic glue injection for gastric varices: International multicentre propensity‐matched analysis
Background Gastric varices (GVs) are conventionally managed with endoscopic cyanoacrylate (E‐CYA) glue injection. Endoscopic ultrasound (EUS)‐guided therapy using combination of coils and CYA glue (EUS‐CG) is a relatively recent modality. There is limited data comparing the two techniques. Methodolo...
Saved in:
| Published in: | Liver international 2023-08, Vol.43 (8), p.1783-1792 |
|---|---|
| Main Authors: | , , , , , , , , , , , , |
| Format: | Article |
| Language: | English |
| Subjects: | |
| Citations: | Items that this one cites Items that cite this one |
| Online Access: | Get full text |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| cited_by | cdi_FETCH-LOGICAL-c3530-9fa4765eb189a6b64319eb0f2b5c382030fbea4c6782044bd4159b8148145f733 |
|---|---|
| cites | cdi_FETCH-LOGICAL-c3530-9fa4765eb189a6b64319eb0f2b5c382030fbea4c6782044bd4159b8148145f733 |
| container_end_page | 1792 |
| container_issue | 8 |
| container_start_page | 1783 |
| container_title | Liver international |
| container_volume | 43 |
| creator | Samanta, Jayanta Nabi, Zaheer Facciorusso, Antonio Dhar, Jahnvi Akbar, Wahid Das, Aritra Birda, Chhagan Lal Mangiavillano, Benedetto Auriemma, Francesco Crino, Stefano Francesco Kochhar, Rakesh Lakhtakia, Sundeep Reddy, Duvvur Nageshwar |
| description | Background
Gastric varices (GVs) are conventionally managed with endoscopic cyanoacrylate (E‐CYA) glue injection. Endoscopic ultrasound (EUS)‐guided therapy using combination of coils and CYA glue (EUS‐CG) is a relatively recent modality. There is limited data comparing the two techniques.
Methodology
This international multicentre study included patients with GV undergoing endotherapy from two Indian and two Italian tertiary care centres. Patients undergoing EUS‐CG were compared with propensity‐matched E‐CYA cases from a cohort of 218 patients. Procedural details such as amount of glue, number of coils used, number of sessions required for obliteration, bleeding after index procedure rates and need for re‐intervention were noted.
Results
Of 276 patients, 58 (male 42, 72.4%; mean age—44.3 ± 12.1 years) underwent EUS‐CG and were compared with 118 propensity‐matched cases of E‐CYA. In the EUS‐CG arm, complete obliteration at 4 weeks was noted in 54 (93.1%) cases. Compared to the E‐CYA cohort, EUS‐CG arm showed significantly lower number of session (1.0 vs. 1.5; p |
| doi_str_mv | 10.1111/liv.15630 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2822374993</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2822374993</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3530-9fa4765eb189a6b64319eb0f2b5c382030fbea4c6782044bd4159b8148145f733</originalsourceid><addsrcrecordid>eNp1kc1OGzEUha0KVCjtoi-ALLGhi4A99vy4OxTREikSi5ZuRx7PneDIY6f2TFB2PALiEfskvSHAAgnL8u-nc-x7CPnK2RnHdu7s-oznhWAfyCGXZTURmeB7r-tMHJBPKS0Z40rl_CM5EGVWKF7IQ_J4efPr3_3DYrQttNQE66j2LV24Eaj1SzCDDZ6uIaYxUfBtSCasrHkLdCHShU5DxKu1xhHSdzrzA0Svt4B2tB_dgOd-iEBXMazAJzts0LvXg7lFc43UJtn0mex32iX48jwfkZsfl7-nV5P59c_Z9GI-MSIXbKI6Lcsih4ZXShdNIQVX0LAua3IjqowJ1jWgpSlK3EjZtJLnqqm4xJ53pRBH5HSni6_5O0Ia6t4mA85pD2FMdVZh5Uqp1BY9eYMuw4hfc1sKi4nWskLq244yMaQUoatX0fY6bmrO6m1QNQZVPwWF7PGz4tj00L6SL8kgcL4D7qyDzftK9Xz2Zyf5H-5UoOs</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2837231948</pqid></control><display><type>article</type><title>EUS‐guided coil and glue injection versus endoscopic glue injection for gastric varices: International multicentre propensity‐matched analysis</title><source>Wiley-Blackwell Read & Publish Collection</source><creator>Samanta, Jayanta ; Nabi, Zaheer ; Facciorusso, Antonio ; Dhar, Jahnvi ; Akbar, Wahid ; Das, Aritra ; Birda, Chhagan Lal ; Mangiavillano, Benedetto ; Auriemma, Francesco ; Crino, Stefano Francesco ; Kochhar, Rakesh ; Lakhtakia, Sundeep ; Reddy, Duvvur Nageshwar</creator><creatorcontrib>Samanta, Jayanta ; Nabi, Zaheer ; Facciorusso, Antonio ; Dhar, Jahnvi ; Akbar, Wahid ; Das, Aritra ; Birda, Chhagan Lal ; Mangiavillano, Benedetto ; Auriemma, Francesco ; Crino, Stefano Francesco ; Kochhar, Rakesh ; Lakhtakia, Sundeep ; Reddy, Duvvur Nageshwar</creatorcontrib><description>Background
Gastric varices (GVs) are conventionally managed with endoscopic cyanoacrylate (E‐CYA) glue injection. Endoscopic ultrasound (EUS)‐guided therapy using combination of coils and CYA glue (EUS‐CG) is a relatively recent modality. There is limited data comparing the two techniques.
Methodology
This international multicentre study included patients with GV undergoing endotherapy from two Indian and two Italian tertiary care centres. Patients undergoing EUS‐CG were compared with propensity‐matched E‐CYA cases from a cohort of 218 patients. Procedural details such as amount of glue, number of coils used, number of sessions required for obliteration, bleeding after index procedure rates and need for re‐intervention were noted.
Results
Of 276 patients, 58 (male 42, 72.4%; mean age—44.3 ± 12.1 years) underwent EUS‐CG and were compared with 118 propensity‐matched cases of E‐CYA. In the EUS‐CG arm, complete obliteration at 4 weeks was noted in 54 (93.1%) cases. Compared to the E‐CYA cohort, EUS‐CG arm showed significantly lower number of session (1.0 vs. 1.5; p < 0.0001) requirement, lower subsequent‐bleeding episodes (13.8% vs. 39.1%; p < 0.0001) and lower re‐intervention (12.1% vs. 50.4%; p < 0.001) rates. On multivariable regression analysis, size of the varix (aOR‐1.17; CI 1.08–1.26) and technique of therapy (aOR‐14.71; CI 4.32–50.0) were significant predictors of re‐bleeding. A maximum GV size >17.5 mm had a 69% predictive accuracy for need for re‐intervention.
Conclusion
Endoscopic ultrasound‐guided therapy of GV using coil and CYA glue is a safe technique with better efficacy and lower re‐bleeding rates on follow‐up compared to the conventional endoscopic CYA therapy.</description><identifier>ISSN: 1478-3223</identifier><identifier>EISSN: 1478-3231</identifier><identifier>DOI: 10.1111/liv.15630</identifier><identifier>PMID: 37269164</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Bleeding ; cyanoacrylate ; Cyanoacrylates ; Endoscopy ; Endosonography - methods ; endotherapy ; Esophageal and Gastric Varices - diagnostic imaging ; Esophageal and Gastric Varices - therapy ; gastroesophageal varices ; gastrointestinal bleeding ; Gastrointestinal Hemorrhage - diagnostic imaging ; Gastrointestinal Hemorrhage - therapy ; Hemostasis, Endoscopic - methods ; Humans ; Injection ; Male ; portal hypertension ; Regression analysis ; Therapy ; Treatment Outcome ; Ultrasonic imaging ; Ultrasound</subject><ispartof>Liver international, 2023-08, Vol.43 (8), p.1783-1792</ispartof><rights>2023 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.</rights><rights>2023 John Wiley & Sons A/S</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3530-9fa4765eb189a6b64319eb0f2b5c382030fbea4c6782044bd4159b8148145f733</citedby><cites>FETCH-LOGICAL-c3530-9fa4765eb189a6b64319eb0f2b5c382030fbea4c6782044bd4159b8148145f733</cites><orcidid>0000-0002-9277-5086 ; 0000-0002-2107-2156 ; 0000-0003-4560-8741</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37269164$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Samanta, Jayanta</creatorcontrib><creatorcontrib>Nabi, Zaheer</creatorcontrib><creatorcontrib>Facciorusso, Antonio</creatorcontrib><creatorcontrib>Dhar, Jahnvi</creatorcontrib><creatorcontrib>Akbar, Wahid</creatorcontrib><creatorcontrib>Das, Aritra</creatorcontrib><creatorcontrib>Birda, Chhagan Lal</creatorcontrib><creatorcontrib>Mangiavillano, Benedetto</creatorcontrib><creatorcontrib>Auriemma, Francesco</creatorcontrib><creatorcontrib>Crino, Stefano Francesco</creatorcontrib><creatorcontrib>Kochhar, Rakesh</creatorcontrib><creatorcontrib>Lakhtakia, Sundeep</creatorcontrib><creatorcontrib>Reddy, Duvvur Nageshwar</creatorcontrib><title>EUS‐guided coil and glue injection versus endoscopic glue injection for gastric varices: International multicentre propensity‐matched analysis</title><title>Liver international</title><addtitle>Liver Int</addtitle><description>Background
Gastric varices (GVs) are conventionally managed with endoscopic cyanoacrylate (E‐CYA) glue injection. Endoscopic ultrasound (EUS)‐guided therapy using combination of coils and CYA glue (EUS‐CG) is a relatively recent modality. There is limited data comparing the two techniques.
Methodology
This international multicentre study included patients with GV undergoing endotherapy from two Indian and two Italian tertiary care centres. Patients undergoing EUS‐CG were compared with propensity‐matched E‐CYA cases from a cohort of 218 patients. Procedural details such as amount of glue, number of coils used, number of sessions required for obliteration, bleeding after index procedure rates and need for re‐intervention were noted.
Results
Of 276 patients, 58 (male 42, 72.4%; mean age—44.3 ± 12.1 years) underwent EUS‐CG and were compared with 118 propensity‐matched cases of E‐CYA. In the EUS‐CG arm, complete obliteration at 4 weeks was noted in 54 (93.1%) cases. Compared to the E‐CYA cohort, EUS‐CG arm showed significantly lower number of session (1.0 vs. 1.5; p < 0.0001) requirement, lower subsequent‐bleeding episodes (13.8% vs. 39.1%; p < 0.0001) and lower re‐intervention (12.1% vs. 50.4%; p < 0.001) rates. On multivariable regression analysis, size of the varix (aOR‐1.17; CI 1.08–1.26) and technique of therapy (aOR‐14.71; CI 4.32–50.0) were significant predictors of re‐bleeding. A maximum GV size >17.5 mm had a 69% predictive accuracy for need for re‐intervention.
Conclusion
Endoscopic ultrasound‐guided therapy of GV using coil and CYA glue is a safe technique with better efficacy and lower re‐bleeding rates on follow‐up compared to the conventional endoscopic CYA therapy.</description><subject>Bleeding</subject><subject>cyanoacrylate</subject><subject>Cyanoacrylates</subject><subject>Endoscopy</subject><subject>Endosonography - methods</subject><subject>endotherapy</subject><subject>Esophageal and Gastric Varices - diagnostic imaging</subject><subject>Esophageal and Gastric Varices - therapy</subject><subject>gastroesophageal varices</subject><subject>gastrointestinal bleeding</subject><subject>Gastrointestinal Hemorrhage - diagnostic imaging</subject><subject>Gastrointestinal Hemorrhage - therapy</subject><subject>Hemostasis, Endoscopic - methods</subject><subject>Humans</subject><subject>Injection</subject><subject>Male</subject><subject>portal hypertension</subject><subject>Regression analysis</subject><subject>Therapy</subject><subject>Treatment Outcome</subject><subject>Ultrasonic imaging</subject><subject>Ultrasound</subject><issn>1478-3223</issn><issn>1478-3231</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><recordid>eNp1kc1OGzEUha0KVCjtoi-ALLGhi4A99vy4OxTREikSi5ZuRx7PneDIY6f2TFB2PALiEfskvSHAAgnL8u-nc-x7CPnK2RnHdu7s-oznhWAfyCGXZTURmeB7r-tMHJBPKS0Z40rl_CM5EGVWKF7IQ_J4efPr3_3DYrQttNQE66j2LV24Eaj1SzCDDZ6uIaYxUfBtSCasrHkLdCHShU5DxKu1xhHSdzrzA0Svt4B2tB_dgOd-iEBXMazAJzts0LvXg7lFc43UJtn0mex32iX48jwfkZsfl7-nV5P59c_Z9GI-MSIXbKI6Lcsih4ZXShdNIQVX0LAua3IjqowJ1jWgpSlK3EjZtJLnqqm4xJ53pRBH5HSni6_5O0Ia6t4mA85pD2FMdVZh5Uqp1BY9eYMuw4hfc1sKi4nWskLq244yMaQUoatX0fY6bmrO6m1QNQZVPwWF7PGz4tj00L6SL8kgcL4D7qyDzftK9Xz2Zyf5H-5UoOs</recordid><startdate>202308</startdate><enddate>202308</enddate><creator>Samanta, Jayanta</creator><creator>Nabi, Zaheer</creator><creator>Facciorusso, Antonio</creator><creator>Dhar, Jahnvi</creator><creator>Akbar, Wahid</creator><creator>Das, Aritra</creator><creator>Birda, Chhagan Lal</creator><creator>Mangiavillano, Benedetto</creator><creator>Auriemma, Francesco</creator><creator>Crino, Stefano Francesco</creator><creator>Kochhar, Rakesh</creator><creator>Lakhtakia, Sundeep</creator><creator>Reddy, Duvvur Nageshwar</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QO</scope><scope>7T5</scope><scope>7U9</scope><scope>8FD</scope><scope>FR3</scope><scope>H94</scope><scope>P64</scope><scope>RC3</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-9277-5086</orcidid><orcidid>https://orcid.org/0000-0002-2107-2156</orcidid><orcidid>https://orcid.org/0000-0003-4560-8741</orcidid></search><sort><creationdate>202308</creationdate><title>EUS‐guided coil and glue injection versus endoscopic glue injection for gastric varices: International multicentre propensity‐matched analysis</title><author>Samanta, Jayanta ; Nabi, Zaheer ; Facciorusso, Antonio ; Dhar, Jahnvi ; Akbar, Wahid ; Das, Aritra ; Birda, Chhagan Lal ; Mangiavillano, Benedetto ; Auriemma, Francesco ; Crino, Stefano Francesco ; Kochhar, Rakesh ; Lakhtakia, Sundeep ; Reddy, Duvvur Nageshwar</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3530-9fa4765eb189a6b64319eb0f2b5c382030fbea4c6782044bd4159b8148145f733</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Bleeding</topic><topic>cyanoacrylate</topic><topic>Cyanoacrylates</topic><topic>Endoscopy</topic><topic>Endosonography - methods</topic><topic>endotherapy</topic><topic>Esophageal and Gastric Varices - diagnostic imaging</topic><topic>Esophageal and Gastric Varices - therapy</topic><topic>gastroesophageal varices</topic><topic>gastrointestinal bleeding</topic><topic>Gastrointestinal Hemorrhage - diagnostic imaging</topic><topic>Gastrointestinal Hemorrhage - therapy</topic><topic>Hemostasis, Endoscopic - methods</topic><topic>Humans</topic><topic>Injection</topic><topic>Male</topic><topic>portal hypertension</topic><topic>Regression analysis</topic><topic>Therapy</topic><topic>Treatment Outcome</topic><topic>Ultrasonic imaging</topic><topic>Ultrasound</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Samanta, Jayanta</creatorcontrib><creatorcontrib>Nabi, Zaheer</creatorcontrib><creatorcontrib>Facciorusso, Antonio</creatorcontrib><creatorcontrib>Dhar, Jahnvi</creatorcontrib><creatorcontrib>Akbar, Wahid</creatorcontrib><creatorcontrib>Das, Aritra</creatorcontrib><creatorcontrib>Birda, Chhagan Lal</creatorcontrib><creatorcontrib>Mangiavillano, Benedetto</creatorcontrib><creatorcontrib>Auriemma, Francesco</creatorcontrib><creatorcontrib>Crino, Stefano Francesco</creatorcontrib><creatorcontrib>Kochhar, Rakesh</creatorcontrib><creatorcontrib>Lakhtakia, Sundeep</creatorcontrib><creatorcontrib>Reddy, Duvvur Nageshwar</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Biotechnology Research Abstracts</collection><collection>Immunology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Liver international</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Samanta, Jayanta</au><au>Nabi, Zaheer</au><au>Facciorusso, Antonio</au><au>Dhar, Jahnvi</au><au>Akbar, Wahid</au><au>Das, Aritra</au><au>Birda, Chhagan Lal</au><au>Mangiavillano, Benedetto</au><au>Auriemma, Francesco</au><au>Crino, Stefano Francesco</au><au>Kochhar, Rakesh</au><au>Lakhtakia, Sundeep</au><au>Reddy, Duvvur Nageshwar</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>EUS‐guided coil and glue injection versus endoscopic glue injection for gastric varices: International multicentre propensity‐matched analysis</atitle><jtitle>Liver international</jtitle><addtitle>Liver Int</addtitle><date>2023-08</date><risdate>2023</risdate><volume>43</volume><issue>8</issue><spage>1783</spage><epage>1792</epage><pages>1783-1792</pages><issn>1478-3223</issn><eissn>1478-3231</eissn><abstract>Background
Gastric varices (GVs) are conventionally managed with endoscopic cyanoacrylate (E‐CYA) glue injection. Endoscopic ultrasound (EUS)‐guided therapy using combination of coils and CYA glue (EUS‐CG) is a relatively recent modality. There is limited data comparing the two techniques.
Methodology
This international multicentre study included patients with GV undergoing endotherapy from two Indian and two Italian tertiary care centres. Patients undergoing EUS‐CG were compared with propensity‐matched E‐CYA cases from a cohort of 218 patients. Procedural details such as amount of glue, number of coils used, number of sessions required for obliteration, bleeding after index procedure rates and need for re‐intervention were noted.
Results
Of 276 patients, 58 (male 42, 72.4%; mean age—44.3 ± 12.1 years) underwent EUS‐CG and were compared with 118 propensity‐matched cases of E‐CYA. In the EUS‐CG arm, complete obliteration at 4 weeks was noted in 54 (93.1%) cases. Compared to the E‐CYA cohort, EUS‐CG arm showed significantly lower number of session (1.0 vs. 1.5; p < 0.0001) requirement, lower subsequent‐bleeding episodes (13.8% vs. 39.1%; p < 0.0001) and lower re‐intervention (12.1% vs. 50.4%; p < 0.001) rates. On multivariable regression analysis, size of the varix (aOR‐1.17; CI 1.08–1.26) and technique of therapy (aOR‐14.71; CI 4.32–50.0) were significant predictors of re‐bleeding. A maximum GV size >17.5 mm had a 69% predictive accuracy for need for re‐intervention.
Conclusion
Endoscopic ultrasound‐guided therapy of GV using coil and CYA glue is a safe technique with better efficacy and lower re‐bleeding rates on follow‐up compared to the conventional endoscopic CYA therapy.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>37269164</pmid><doi>10.1111/liv.15630</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0002-9277-5086</orcidid><orcidid>https://orcid.org/0000-0002-2107-2156</orcidid><orcidid>https://orcid.org/0000-0003-4560-8741</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1478-3223 |
| ispartof | Liver international, 2023-08, Vol.43 (8), p.1783-1792 |
| issn | 1478-3223 1478-3231 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2822374993 |
| source | Wiley-Blackwell Read & Publish Collection |
| subjects | Bleeding cyanoacrylate Cyanoacrylates Endoscopy Endosonography - methods endotherapy Esophageal and Gastric Varices - diagnostic imaging Esophageal and Gastric Varices - therapy gastroesophageal varices gastrointestinal bleeding Gastrointestinal Hemorrhage - diagnostic imaging Gastrointestinal Hemorrhage - therapy Hemostasis, Endoscopic - methods Humans Injection Male portal hypertension Regression analysis Therapy Treatment Outcome Ultrasonic imaging Ultrasound |
| title | EUS‐guided coil and glue injection versus endoscopic glue injection for gastric varices: International multicentre propensity‐matched analysis |
| url | http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-29T06%3A40%3A42IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=EUS%E2%80%90guided%20coil%20and%20glue%20injection%20versus%20endoscopic%20glue%20injection%20for%20gastric%20varices:%20International%20multicentre%20propensity%E2%80%90matched%20analysis&rft.jtitle=Liver%20international&rft.au=Samanta,%20Jayanta&rft.date=2023-08&rft.volume=43&rft.issue=8&rft.spage=1783&rft.epage=1792&rft.pages=1783-1792&rft.issn=1478-3223&rft.eissn=1478-3231&rft_id=info:doi/10.1111/liv.15630&rft_dat=%3Cproquest_cross%3E2822374993%3C/proquest_cross%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-c3530-9fa4765eb189a6b64319eb0f2b5c382030fbea4c6782044bd4159b8148145f733%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=2837231948&rft_id=info:pmid/37269164&rfr_iscdi=true |